Laserfiche WebLink
ONSITE WE',' TEWATER TREATMENT SY EVI PERM <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALki DEPARTMENT 304 E WEBL,"V£ -34"FL-STOCK e�N CA 95202 - (209)468-3420 <br /> 1. <br /> NON-REFUNDABLE PERMIT CALL(209)953-7 97 FOR INSPECTIONS EXPIRES l YEAR FROM DATE ISSUED <br /> JOB ADDRESS 42 O 0 �Gt/ CITYILiP X1//l/REN. 95-236 L <br /> CROSS STREET r M Ab APN [J-/ t//O 19 PARC SIIZZE p <br /> OWNER NAME U / PHONE 26 <br /> OWNER ADDRESS /moo6z.. IIEw fT !�✓ C IZ1P LIA1DEA y FF 3 1� <br /> fCO r/� w, 660 - 1 03 <br /> CONTRACTOR J tt.L 'V PHONE <br /> CONTRACTOR ADDRESS F . 0 0 0 X 7 7 CITYISTATEIZ[P 7 k R L.D GIL <br /> , <br /> LICENSE ❑C-42 ❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WA ER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION. Coordinates X Y <br /> Far PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> { TYPE OF WORK; ❑ NEW INSTALLATION ❑ REPAIRIADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE {� <br /> ❑ REPLACEMENT ❑ DESTRUCTION �} <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE D COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKG TX PLANT DISTANCE TO NEAREST.. WELL ft FOUNDATION ft PROPERTY LINE ft <br /> D LIFT STATION SIZE TYPE OF PUMP ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> D LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> ! DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 1 HEREBY CE IFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> DINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY, <br /> MIN OUR ADVANCE NOTICE REQUIRED FOR INSPEC,fT�IIO�N�S�-PLEASE CALL(209)953-7697 <br /> SIGNED � `" - DATE _L '1r3, 0-S' <br /> it _ 6 l <br /> _ ca <br /> 12 <br /> 1 El <br /> I kt:lv ' <br /> { J <br /> !IHCENE <br /> L <br /> i <br /> S N O Q I <br /> w="T-M'6P4TI4E T <br /> DEPARTMENT USE ONLY �J <br /> ApplicationAcceptedBy 4,_ _ y Date�` "�i - - •Are_a Employee IDA <br /> Final Inspection By- Date Zihs ❑ SPECIAL PERMIT-Approved by <br /> F' Character of Soil to D4pth of 3t: P(Sump Soil Character: - <br /> 1 COMMENTS vr� ��- 5E <br /> s ' <br /> PE SC Receivedeee Amount Permit/ <br /> Code INFO By Cash Remitted Date Service Request# Invoice# Permit IDA <br /> 42-02-001 ONSITE WASTEWATER 1 <br /> 12/22/2003 <br />